The online home of Paul McNamara: Nurse. Educator. Digital Citizen.

Tag Archives: postnatal

Previously for Perinatal Mental Health Workshops I have trickled-out the links and resources we refer to during the workshop via Twitter and Facebook. It’s a nice idea, and has worked pretty well (for more information about this experiment in social media enhanced education please see the video below and/or this link: meta4RN.com/workshop).

However, it is pretty labour-intensive to pre-schedule each individual Tweet and Facebook post every time I facilitate a Perinatal Mental Health Workshop, so to save some mucking-around I’ll list the links and resources here.

The headings in red are not mutually exclusive – some links cross boundaries. The list/links will be updated PRN:

Guiding Clinical Practice

2014 Cairns Perinatal Mental Health Workshops (follow the link for info about the workshops and for free registration) pmh.eventbrite.com.au

ACMHN Perinatal Mental Health Online CPD Program (a 3 module continuing professional development program which is open to Australian College of Mental Health Nurses members [free] and non-member nurses and midwives [$33 including GST]) www.acmhn.org/perinatal-elearning

beyondblue (lots of resources, including booklets regarding emotional health in pregnancy and early parenthood, some multilingual booklets) www.beyondblue.org.au

Mind the Bump is a free Mindfulness Meditation App to help individuals and couples support their mental and emotional wellbeing in preparation for having a baby and becoming a new parent www.mindthebump.org.au

Black Dog Institute (info and resources re perinatal depression for women and men; presented in a different style to beyond blue’s info) www.blackdoginstitute.org.au

Doc Ready (for those not sure how to start a conversation about mental health with your midwife, nurse or doctor? maybe building a checklist will help) docready.org

MindHealthConnect (good place to find trusted mental health programs, fact sheets, and to access urgent support via the red “Need Help Now?” button on each page) www.mindhealthconnect.org.au

Puerperal Psychosis

Information on Puerperal Psychosis (2010) by Dr Anne Sven Williams and Sue Ellershaw (be alert, not alarmed: a self-downloading DOC; the target audience for this is women/families affected by puerperal psychosis, but many of us clinicians have also found it a useful adjunct to our formal education) www.wch.sa.gov.au

Most health messages are such a downer, surely there are many people who will either switch-off from the message, or become unduly alarmed. Compare health marketing to commercial marketing and it’s no wonder obesity is rising. Put frankly, Coca-Cola and McDonalds have better ads: they’re full of fun and optimism:

Things Go Better With Coke!

McDonalds – I’m Lovin’ It!

Don’t get me wrong: depression is a bugger of a thing, and perinatal mood disorders are especially poorly timed. Looking after a pregnancy/baby is tricky enough without tossing in anxiety and/or depression.

However, at the risk of sounding all Pollyanna about it, there are some good news stories we can talk about when discussing perinatal mental health. Here’s a small list of things I’d like mentioned in every antenatal class/similar forum for parents-to-be/new parents:

[1] 6 in 7 new mothers and 19 in 20 new fathers will not experience perinatal depression. Are there any other gambles that give you better odds?

[2]Symptoms are usually easy to recognise. There’s even a free online anonymous self-scoring tool available: justspeakup.com.au/epds

[3]If somebody is not sure how to start a conversation about mental health with their midwife, doctor or child health nurse, there’s a handy online tool to help build a checklist of things to mention: docready.org

[4] Information and resources are easy to find. In Australia the “big five” are:

[10] Mental health clinicians are not interested in stealing the baby. In fact, mental health clinicians seem quite pleased with themselves when they get to see parents and infants connecting and communicating with each other.

[11]If attachment between parent and baby does not happen as easily as expected (this happens a fair bit with anxiety and/or depression), there are video guides to help, for example: Baby Cues Also, in some towns and cities (especially those with a perinatal and infant mental health nurse), there are clinical staff who can help with this communication/attachment/bonding stuff too.

What’s This About Exactly?

During the week a couple of new mums declined referral to see a nurse (me) from the consultation liaison psychiatry service because they had preconceptions about how negative the experience would be. It’s not absolutely necessary for every parent to see a mental health specialist, of course, but I think we (that’s “we the health professionals”) should start fishing-around for ways to better describe the good news stories about perinatal mental health.

diabetes, that is

If Coca-Cola and McDonalds can convey a sense of fun and optimism out of the products they sell, surely we can convey a sense of fun and optimism out of the services we provide. We have something that’s much better than the offerings of either Coca-Cola or McDonalds, so let’s reorientate the language and recalibrate expectations by using positive language.

Maybe when perinatal and infant mental health (PIMH) services in Queensland are re-established, we can re-launch with an upbeat attitude and slogan:

PIMH for a healthy head-start!

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What are your ideas for upbeat slogans and messages? Please add them in the comments section below.

Back in June 2011 I was employed as a perinatal mental health nurse, and was working in partnership with midwives, child health nurses, GPs, Indigenous health workers, allied health staff and obstetricians to provide and develop easy, smooth pathways to mental health care for pregnant women and new mums who needed a bit of extra support.

It would be fair to say that availability of specialist perinatal mental health service in Australia has been patchy. In some health districts, perinatal mental health services have evolved without specific funding, often emerging as a component of consultation liaison mental health. However, until recently there hasn’t been a coordinated approach to perinatal mental health at a national level. This should be addressed, in part at least, by Federal, State and Territory Governments using National Perinatal Depression Initiative funding to seed specific services and models of service delivery at various urban and regional centres. In Queensland, for example, there will a dozen or so ‘perinatal mental health clinical nurse consultants’ seeded in a number of strategic locations around the state, with the hope/intent of developing sustainable referral pathways and contributing to workforce training and development in this area.

Boy, did I get that wrong.

There were a dozen or so perinatal mental health clinical nurse consultants in Queensland Health up until June 2013. Now there are three: two on the northern side of Brisbane and one in Toowoomba. Apparently (if the grapevine is correct) there are funded perinatal mental health positions in Townsville and Gold Coast too, it’s just that they’re both empty at the moment. That leaves two out of sixteen Queensland Hospital and Health Services currently with access to a perinatal mental health nurse.

2% of Australia’s population lives in the yellow area. Source: @Amazing_Maps

For the many health districts that have lost the specialist perinatal mental health nurse, the only alternative is to ask the woman to use phone support or see their GP instead.

But there are problems with both the phone support and the GP option.

Look, I have nothing but admiration for GPs – they’re at the frontline of primary health care and tend to be a very versatile bunch. But, let’s face it: most GPs are as busy as a one-armed Sydney taxi-driver with an ice-cream and an itch. It’s a big ask for the GP and the pregnant woman/new mum to make the time and head space available for ventilating, understanding and re-packaging strong emotions.

When I’m meeting with somebody who is experiencing symptoms of depression, anxiety or other mental health difficulties, it usually takes me an hour or so to feel that I have provided an outlet for the distress, and gained an understanding of what strategies and services we should use to support the person.

Maybe I have just have slow ears.

Maybe GPs can hear, understand and sensitively respond to those complex stories of loss, grief, trauma and unmet expectations quicker than I can.

Or maybe, just maybe, the families that have lost easy access to a specialist perinatal mental health nurse have lost easy access to support.

In a cruel double-whammy, at the same time perinatal mental health nurse positions in Queensland were disappearing, the national perinatal mental health telephone support line was also becoming less accessible. Since midway through 2013 PANDA’s National Perinatal Depression Helpline has had to cut-back on available hours to 10:00am to 5:00pm Monday to Friday. This time last year it was 9:00am to 9:00pm Monday to Friday. Earlier this year the Million Mums in May campaign was hoping to get funding for PANDA to offer a 24 hour, 7 day-per-week service.

When perinatal mental health services on the ground are being cut in various places around the country, wouldn’t that be a good time to expand and promote the accessibility of the national helpline? Unfortunately, the opposite has occurred.

It is not all doom and gloom: if parents live within cooee of a St John of God Raphael Centre or near of the long-established state-run perinatal mental health services (usually in capital cities), access to support is still pretty good.

However, coverage is patchy: Australia’s “National” Perinatal Depression Initiative is anything but national. The “national” part is a myth.

Access to specialist perinatal mental health services in Australia is a postcode lottery and, as with all lotteries, there are a lot of losing tickets.

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As always, your feedback and comments are welcome below.

As there have been no formal announcements/media releases about perinatal mental health services contracting, I have had to rely on first-hand knowledge and, to a lesser extent, hearsay via “the grapevine”.

If there any factual errors as at November 2013 please let me know. Naturally, i would like to make any necessary correction(s) as soon as practical.

Ever noticed how in the USA the term “postpartum depression” is used more often than here in Australia, where we mostly use the term “postnatal depression”? In the UK, from my online vantage-point anyway, it seems more mixed – as if the two terms are interchangeable.

What’s the difference? Is it like, “You say potato, I say potato. You say tomato, I say tomato.”?

What about “perinatal mental health” – what’s that all about?

What’s the difference between “prenatal”, “antenatal” and “antinatal”?

What’s “puerperal” – something to do with caterpillars?

Words do matter. Many years ago I made the mistake of asking if the lady I was following-up had delivered. I was very firmly advised by my colleague, a Midwife, that, “Babies are born. Women give birth. Pizzas are delivered.” I was suitably chastened and, although not a midwife myself, I have tried to stay on top of most of the language midwives use.

So, with that spirit of adventure, let’s see if we can get our heads around some key words in today’s perinatal jargon-busting post.

Let’s get started with the basics:

“Natal” = relating to an infant being born

“Partum” = relating to a woman giving birth

“Peri” = around/about

“Perinatal” = around the time of birth, that is: both before and after the baby is born.

Generally (not always) in the mental health clinical context, we think of the perinatal period as being over three phases: 1. planning pregnancy; 2. pregnant; 3. new parent.

Just choose your definition of when the perinatal period should begin and end – from what we’ve seen above that’s what everyone else is doing.

Perry Natal is on facebook

“Perry Natal” is on facebook – judging by his profile pic, he seems like a pretty fun guy. As far as I can tell he has no relationship to the perinatal period.

I like to think that Perry Natal gets a lot of enjoyment out of confusing health professionals who work with pregnant women and new mums… “She’s not perinatal! I’m Perry Natal!” Why is that so hard for you to understand? A man can be Perry Natal without there being a perinatal woman!”

Fun times.

“Prenatal” refers to pregnancy. I don’t think it gets used all that much in Australia – not that I’ve noticed, anyway. Semantically, it makes sense to use prenatal, but the usual convention seems to be to use the word “antenatal”.

“Antenatal” gets used all the time to refer to pregnancy. “Ante” = before, so antenatal = before the infant is born.

“Anti Natal” is either a spelling mistake, or an indication that somebody really hates Natal – the capital and largest city of Rio Grande do Norte, a northeastern state in Brazil. It is hard to imagine anyone hating Natal – it looks very pleasant, is considered the safest capital city in Brazil, and is home to the largest cashew tree in the world! Everyone loves cashews, don’t they?

“Antepartum” is not a word I’ve heard used alone as replacement for “antenatal”, although I guess it could be. The word pops-up as a descriptor for a medical emergency that sometimes occurs after 20 weeks gestation: “antepartum haemorrhage” (aka APH). It’s probably used in other contexts too – please feel free to add anything important I’ve overlooked in the comments section below.

Labour and childbirth may attract the descriptors “Intranatal” if it relates to the baby, and ‘intrapartum” as it relates to the woman.

“Postnatal” is after the infant has been born. Literally speaking, everyone can participate in the postnatal period – baby, mum, dad, and whoever is there after the baby is born. Semantically this is why dads can experience postnatal depression.

As with the definition of perinatal, definitions of how long the postnatal period lasts vary a lot. Generally when we’re thinking about postnatal depression we think mostly about the first six or twelve months, but it wouldn’t be unusual to think of any depression that arrives before baby’s third birthday as postnatal depression.

“Postpartum” is after the woman has given birth.

If we get bogged-down in the semantics, I’m pretty sure only a woman who has given birth can experience postpartum depression. Why? Because only the woman is postpartum, the baby and man are postnatal.

That said, it’s also pretty safe to say that hardly anyone gets bogged-down in the semantics. In common usage “postpartum depression” is applied to both women and men, and as with “postnatal depression’ there are varied definitions of how long the postpartum period lasts when it is related to depression. I think obstetricians and midwives have a much more defined, discrete definition on how long the postpartum period is, and sometimes refer to it as the “fourth stage of labor”.

“Puerperal” or “the puerperium” relates to the time from immediately after birth of the placenta to six weeks, with an emphasis on the first two weeks.

In mental health the puerperium is especially noteworthy for two things:

[1] Something like 80%-90% of first-time mums will experience the baby blues in the puerperium. It’s a transient, self-resolving emotional lability that arrives within a few days of childbirth and goes away within hours or (if you’re a bit unlucky) a few days. More info here.

[2] Much, much rarer – something that affects one or two women per thousand births – is puerperal psychosis. “Psychosis” = losing touch with reality. To lose touch with reality at any time is pretty scary; to do so when there’s a brand-new baby on the scene even more so. This is nearly always a very frightening time for the woman and the people who love her; specialist mental health support will certainly be required. For more info, there are two great puerperal psychosis resources available via the Helen Mayo House website:

Which brings me back to where the idea for this post started. Broadly, when people use any of the terms “postnatal psychosis”, “postpartum psychosis” and “puerperal psychosis”, they’re usually talking about the same thing. I would make the distinction that puerperal psychosis is specific to onset of symptoms in the first fortnight or so after birth. Similarly, “postnatal depression” and “postpartum depression” are used pretty-much as interchangeable terms, even though there are semantic differences… same with the abbreviations PND and PPD.

Maybe this picture clears it up:

If the illustrated summary is of any use, there is an easier-to-print PDF version here.

As always, your thoughts/comments/corrections are welcome in the section below.